Provider Demographics
NPI:1306515564
Name:SIMMS, ALISHA
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:SIMMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 BAGWELL AVE
Mailing Address - Street 2:
Mailing Address - City:NUTTER FORT
Mailing Address - State:WV
Mailing Address - Zip Code:26301-4372
Mailing Address - Country:US
Mailing Address - Phone:681-753-8212
Mailing Address - Fax:
Practice Address - Street 1:204 BAGWELL AVE
Practice Address - Street 2:
Practice Address - City:NUTTER FORT
Practice Address - State:WV
Practice Address - Zip Code:26301-4372
Practice Address - Country:US
Practice Address - Phone:681-753-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker